Provider Demographics
NPI:1952689507
Name:BAEK, MYUNGWON JOYCE (DMD)
Entity Type:Individual
Prefix:
First Name:MYUNGWON
Middle Name:JOYCE
Last Name:BAEK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHERRY ST # R
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3201
Mailing Address - Country:US
Mailing Address - Phone:617-416-0973
Mailing Address - Fax:
Practice Address - Street 1:1795 MAIN ST STE 116
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1078
Practice Address - Country:US
Practice Address - Phone:413-439-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist